Advertisement

Pediatric Radiology

, 41:1008 | Cite as

SPECT/CT imaging in children with papillary thyroid carcinoma

  • Hwa-Young Kim
  • Michael J. GelfandEmail author
  • Susan E. Sharp
Original Article

Abstract

Background

SPECT/CT improves localization of single photon-emitting radiopharmaceuticals.

Objective

To determine the utility of SPECT/CT in children with papillary thyroid carcinoma.

Materials and methods

20 SPECT/CT and planar studies were reviewed in 13 children with papillary thyroid carcinoma after total thyroidectomy. Seven studies used I-123 and 13 used I-131, after elevating TSH by T4 deprivation or intramuscular thyrotropin alfa. Eight children had one study and five children had two to four studies. Studies were performed at initial post-total thyroidectomy evaluation, follow-up and after I-131 treatment doses. SPECT/CT was performed with a diagnostic-quality CT unit in 13 studies and a localization-only CT unit in 7. Stimulated thyroglobulin was measured (except in 2 cases with anti-thyroglobulin antibodies).

Results

In 13 studies, neck activity was present but poorly localized on planar imaging; all foci of uptake were precisely localized by SPECT/CT. Two additional foci of neck uptake were found on SPECT/CT. SPECT/CT differentiated high neck uptake from facial activity. In six studies (four children), neck uptake was identified as benign by SPECT/CT (three thyroglossal duct remnants, one skin contamination, two by precise anatomical CT localization). In two children, SPECT/CT supported a decision not to treat with I-131. When SPECT/CT was unable to identify focal uptake as benign, stimulated thyroglobulin measurements were valuable. In three of 13 studies with neck uptake, SPECT/CT provided no useful additional information.

Conclusion

SPECT/CT precisely localizes neck iodine uptake. In small numbers of patients, treatment is affected. SPECT/CT should be used when available in thyroid carcinoma patients.

Keywords

Thyroid cancer Radioactive iodine SPECT/CT Neck imaging Pediatrics 

References

  1. 1.
    Bockisch A, Freudenberg LS, Schmidt D et al (2009) Hybrid imaging by SPECT/CT and PET/CT: proven outcomes in cancer imaging. Semin Nucl Med 39:276–289PubMedCrossRefGoogle Scholar
  2. 2.
    Aide N, Heutte N, Rame JP et al (2009) Clinical relevance of single-photon emission computed tomography/computed tomography of the neck and thorax in postablation (131)I scintigraphy for thyroid cancer. J Clin Endocrinol Metab 94:2075–2084PubMedCrossRefGoogle Scholar
  3. 3.
    Tharp K, Israel O, Hausmann J et al (2004) Impact of 131I-SPECT/CT images obtained with an integrated system in the follow-up of patients with thyroid carcinoma. Eur J Nucl Med Mol Imaging 31:1435–1442PubMedCrossRefGoogle Scholar
  4. 4.
    Wong KK, Zarzhevsky N, Cahill JM et al (2008) Incremental value of diagnostic 131I SPECT/CT fusion imaging in the evaluation of differentiated thyroid carcinoma. AJR 191:1785–1794PubMedCrossRefGoogle Scholar
  5. 5.
    Wang H, Fu HL, Li JN et al (2009) The role of single-photon emission computed tomography/computed tomography for precise localization of metastases in patients with differentiated thyroid cancer. Clin Imaging 33:49–54PubMedCrossRefGoogle Scholar
  6. 6.
    Chen L, Luo Q, Shen Y et al (2008) Incremental value of 131I SPECT/CT in the management of patients with differentiated thyroid carcinoma. J Nucl Med 49:1952–1957PubMedCrossRefGoogle Scholar
  7. 7.
    Kohlfuerst S, Igerc I, Lobnig M et al (2009) Posttherapeutic (131)I SPECT-CT offers high diagnostic accuracy when the findings on conventional planar imaging are inconclusive and allows a tailored patient treatment regimen. Eur J Nucl Med Mol Imaging 36:886–893PubMedCrossRefGoogle Scholar
  8. 8.
    Schmidt D, Szikszai A, Linke R et al (2009) Impact of 131I SPECT/spiral CT on nodal staging of differentiated thyroid carcinoma at the first radioablation. J Nucl Med 50:18–23PubMedCrossRefGoogle Scholar
  9. 9.
    ImPACT. London, UK. www.impactscan.org
  10. 10.
    O’Gorman CS, Hamilton J, Rachmiel M et al (2010) Thyroid cancer in childhood: a retrospective review of childhood course. Thyroid 20:375–380PubMedCrossRefGoogle Scholar
  11. 11.
    Lee SW, Lee J, Lee HJ et al (2007) Enhanced scintigraphic visualization of thyroglossal duct remnant during hypothyroidism after total thyroidectomy: prevalence and clinical implication in patients with differentiated thyroid cancer. Thyroid 17:341–346PubMedCrossRefGoogle Scholar
  12. 12.
    Sisson JC, Dewaraja YK, Wizauer EJ et al (2009) Thyroid carcinoma metastasis to skull with infringement of brain: treatment with radioiodine. Thyroid 19:297–303PubMedCrossRefGoogle Scholar
  13. 13.
    Freudenberg LS, Fromke C, Petrich T et al (2010) Thyroid remnant dose: 124I-PET/CT dosimetric comparison of rhTSH versus thyroid hormone withholding before radioiodine remnant ablation in differentiated thyroid cancer. Exp Clin Endocrinol Diabetes 118:393–399PubMedCrossRefGoogle Scholar
  14. 14.
    Freudenberg LS, Jentzen W, Marlowe RJ et al (2007) 124-iodine positron emission tomography/computed tomography dosimetry in pediatric patients with differentiated thyroid cancer. Exp Clin Endocrinol Diabetes 115:690–693PubMedCrossRefGoogle Scholar
  15. 15.
    Kolbert KS, Pentlow KS, Pearson JR et al (2007) Prediction of absorbed dose to normal organs in thyroid cancer patients treated with 131I by use of 124I PET and 3-dimensional internal dosimetry software. J Nucl Med 48:143–149PubMedGoogle Scholar
  16. 16.
    Freudenberg LS, Frilling A, Kuhl H et al (2007) Dual-modality FDG-PET/CT in follow-up of patients with recurrent iodine-negative differentiated thyroid cancer. Eur Radiol 17:3139–3147PubMedCrossRefGoogle Scholar
  17. 17.
    Saab G, Driedger AA, Pavlosky W et al (2006) Thyroid-stimulating hormone-stimulated fused positron emission tomography/computed tomography in the evaluation of recurrence in 131I-negative papillary thyroid carcinoma. Thyroid 16:267–272PubMedCrossRefGoogle Scholar
  18. 18.
    Wong KK, Zarzhevsky N, Cahill JM et al (2009) Hybrid SPECT-CT and PET-CT imaging of differentiated thyroid carcinoma. Br J Radiol 82:860–876PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Hwa-Young Kim
    • 1
  • Michael J. Gelfand
    • 1
    Email author
  • Susan E. Sharp
    • 1
  1. 1.Department of RadiologyCincinnati Children’s HospitalCincinnatiUSA

Personalised recommendations